Antithrombotic Treatment after Catheter-based Arterial Interventions

摘要

The rapid advances in balloon and stent technology for the treatment of arterial and venous lesions have been abetted by the use of a variety of anticoagulants. Warfarin was the first agent used after a canine experiment by Palmaz and colleagues93 that showed decreased platelet deposition on intravascular stents in the group treated with a combination of heparin, aspirin, dipyridamole, and dextran compared with the groups treated with heparin alone or heparin with aspirin. Somehow, the authors concluded that warfarin should be added to patients as a "safety net." As a result, the early stent trials and the FDA incorporated warfarin into their guidelines. In 1991 the focus changed away from warfarin in an attempt to reduce bleeding complications, shorten hospital stays, and improve outcomes towards aspirin and ticlopidine.94 Data were collected largely in registries; a large meta-analysis of 2295 patients revealed a statistically significant and clinically meaningful improvement in results after coronary stenting in patients who received ticlopidine therapy. Because the comparisons were uncontrolled, the transition from warfarin to ticlopidine was slow in the United States, as reflected in a consensus document from the American College of Cardiology in 1996 that still recommended warfarin anticoagulation for high-risk stent deployments.